Mind-body medicine, based on the impressive research documenting the relationships between our thought processes and our physiology, has been acknowledged but, it seems, not embraced by most of the medical community. Scientific advances in the field of psychoneuroimmunology have not been effectively translated into widespread use of mind-body techniques in clinical practice. The mind-body connection somehow seems to be a "disconnect" for most physicians. We should consider what factors hinder us from using these powerful tools to improve our patients', and our own, lives. 

Dr. Herbert Benson, a Harvard trained cardiologist and well known author, compellingly presents much of the evidence for the mind-body connection in his popular books, "The Relaxation Response" and "Timeless Healing." An excellent review article, published recently in the New England Journal of Medicine , summarizes how stress alters physiology and highlights the therapeutic implications of this knowledge. Learning to modulate the stress response and evoke the relaxation response is profoundly relevant in both cardiovascular disease and cancer, the most common causes of morbidity and mortality in North America. 

Scientific Reductionism vs. Art 
The scientific evidence is clear that we cannot treat our patients as if they were simply collections of myosin, troponin, ATP, membranes, receptors, fluids and solutes. Science has reached the point of proving it's own insufficiency in medicine. It is increasingly apparent that the art of medicine is equally, if not more important than the science. The tendency to position ourselves as scientists may actually work against us and make us less effective clinicians because we're afraid of losing credibility if we practice an art. Mind-body medicine, while supported by science, is clearly more of an art. This may in part explain why many physicians, reluctant to appear unscientific, are resistant to incorporating mind-body therapies in their practice. If we focus more on what is in the best interest of patients and less on our image it will be easier to balance the art and science of medicine. 

Balanced Lives 
The tendency of physicians to lead unbalanced lives, deprived of sleep, nurturing, family time, reflection and recreation makes it much harder to acknowledge the need for these in our patients' lives. In fact our physician culture trains us, through medical school and residency, to actually admire and emulate those physicians who lead the least balanced lives. 

One of the local hospitals offers an excellent course on stress reduction and relaxation techniques. Participants who somehow manage to find their way to this course often note profound improvements in health as a result of the techniques they learn. Unfortunately, despite promotion of the course to a medical staff of several hundred, only one or two physicians are referring patients to this program. How can we sincerely encourage patients to do what we ourselves are unwilling to do? 

Placebo - Friend or Foe?
The scientific need to identify and eliminate the placebo effect for research purposes is often misconstrued to mean that there is no place for the use of placebos in clinical practice. Nothing could be farther from the truth! The placebo effect is actually one of the most powerful mind-body tools available - in some studies showing up to a 70 - 80 percent response rate. While the placebo effect is the researcher's foe it is the clinician's friend. If we can get over our disdain for placebos we can use them to harness our patients' mind-body resources to dramatically improve their physiology. 

Time - Friend or Foe? 
The hurried pace of our practices makes it difficult to spend the additional time needed for many mind-body interventions. The equally hurried pace of our patients' lives and the desire for immediate results often makes our patients less receptive to using mind-body techniques which need to be learned and practiced regularly. The tyranny of time tends to encourage physicians to assume an aggressive interventional role while patients assume a more passive role. Relating to time as a friend rather than a foe allows patients and physicians to develop a more balanced relationship which discusses and uses mind-body techniques appropriately. 

Mindful Medicine
Living our lives mindfully and encouraging our patients to live their lives mindfully embodies both the science and art of medicine. We should be versed in the many tools available to tap into the powerful mind-body connection. These tools include, among others, meditation, prayer, biofeedback, guided imagery and the much maligned placebo effect. Aside from the placebo effect all of these tools require active, conscious participation by the patient. 

To learn more about how mind-body medicine might fit into your practice I encourage you to read some of Dr. Benson's books or attend one of the seminars or workshops organized by him. Dr. Benson and others will be addressing some of these issues at an all day CME conference in Denver on Monday, April 27, 1998. The conference entitled "Options in Life, Options in Health - A Look at Alternative Medicine" is being organized and sponsored by Centura Health. You might want to mark this on your calendars.